EFFICIENCY OF ENDOTHELIAL DYSFUNCTION CORRECTION OF VESSELS IN THE PERI- AND POSTOPERATIVE PERIOD IN PATIENTS WITH ACUTE CORONARY SYNDROME ON THE BACKGROUND OF TYPE 2 DIABETES
Keywords:acute coronary syndrome, type 2 diabetes, nitrous oxide, endothelin-1, percutaneous coronary intervention, reperfusion complications, L-carnitine, dapagliflozin
Introduction. The high level of morbidity and mortality of patients with myocardial infarction and type 2 diabetes and the limitation of the possibility of using highly effective early invasive coronary interventions in this comorbid condition determines the tactics of active study of the role of mutually aggravating pathogenetic factors, including vascular endothelial dysfunction, which contributes to energetic metabolism disorders and ischemic damage of cardiomyocytes.
The aim of the study – to analyze the effectiveness of the correction of endothelial dysfunction of combined interventional and drug treatment in patients with ST elevation acute coronary syndrome against the background of type 2 diabetes with a high risk of developing cardial complications at the inpatient stage of treatment.
Research Methods. 56 patients with acute coronary syndrome in combination with type 2 diabetes were included in the study. They were divided into 2 groups. 32 patients of the main research group, who in addition to standard treatment with acute coronary syndrome received 2.0 g of L-carnitine intravenously in the form of a solution for infusions of 100 ml once per day due to 7 days. One infusion of the drug was performed before interventional intervention. The control group included 24 patients who also underwent percutaneous coronary intervention and standard medical treatment. To compensate for type 2 diabetes, patients of both groups were additionally prescribed dapagliflozin (Forxiga) 10 mg/day. In addition to general clinical, instrumental and laboratory methods, the functional state of the vascular endothelium was determined by the concentration of endothelin-1 (ET-1) in blood plasma and the content of stable NO metabolites.
Results and Discussion. In the initial state, severe microcirculation and endothelial function disorders and their additional deterioration in the peri- and postoperative periods after percutaneous coronary intervention, accompanied by the development of reperfusion syndrome with varying duration and severity of left ventricular failure and rhythm and conduction disturbances, were found in patients with acute coronary syndrome in combination with type 2 diabetes. Under the influence of standard medical treatment, the presence of treatment-resistant supraventricular and ventricular extrasystoles was noted in patients of the control group. At the same time, in patients with ST elevation acute coronary syndrome in combination with type 2 diabetes of the research group, under the influence of complex drug treatment including L-carnitine and dapagliflozin, already on the second day of observation, a significant improvement of the endothelial function of the vessels parameters and a decrease in the frequency of rhythm and conduction disturbances were noted. And after the end of the treatment course in comorbid patients of the research group, a complete recovery of endothelial function and a decrease in the frequency of rhythm and conduction disturbances by 59.4 % and manifestations of acute heart failure by 42.6 % were noted.
Conclusions. Violation of endothelial function in patients with acute coronary syndrome on the background of type 2 diabetes is advisable to be corrected by metabolic therapy with L-carnitine and the sglt2 inhibitor dapagliflozin in the preoperative period of percutaneous coronary intervention to prevent manifestations of reperfusion syndrome and to continue it in the postoperative period to stabilize the clinical condition of patients and prevent complications.
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